# A 60-year-old client with type 2 diabetes is newly prescribed sitagliptin 100 mg orally daily. Which statement by the client demonstrates correct understanding?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375083&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 60-year-old client with type 2 diabetes is newly prescribed sitagliptin 100 mg orally daily. Which statement by the client demonstrates correct understanding?

## Option

1. I will skip the dose if my blood sugar is normal that morning.
2. I will report severe abdominal pain that radiates to my back, persistent nausea, or new joint pain — these may indicate pancreatitis or other adverse effects of this DPP-4 inhibitor. **✔ Correct answer**
3. I will check my blood glucose every hour because sitagliptin causes severe hypoglycemia.
4. I should chew sitagliptin tablets for faster absorption.

**Correct answer: 2**

## Explanation

DPP-4 inhibitors — patient teaching
DPP-4 inhibitors (the gliptins): sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin. Mechanism: inhibit dipeptidyl peptidase-4 → prolonged endogenous incretin (GLP-1, GIP) → glucose-dependent insulin secretion + decreased glucagon. Generally well tolerated; typically once daily oral.

Key teaching:
• Hypoglycemia risk is LOW as monotherapy (glucose-dependent action). Routine hourly checks not needed; standard SMBG and A1c follow.
• Pancreatitis (rare but reportable): severe abdominal pain radiating to the back, persistent nausea/vomiting — stop the drug and notify the provider.
• Severe joint pain — class warning; can occur weeks to years after initiation; usually resolves on discontinuation.
• Heart failure: saxagliptin and alogliptin associated with HF hospitalization — caution in HF patients.
• Renal dose adjustment: sitagliptin reduce dose in CrCl

## In-depth explanation

Clinical reasoning summary
DPP-4 inhibitors — patient teaching
DPP-4 inhibitors (the gliptins): sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin. Mechanism: inhibit dipeptidyl peptidase-4 → prolonged endogenous incretin (GLP-1, GIP) → glucose-dependent insulin secretion + decreased glucagon. Generally well tolerated; typically once daily oral.

Key teaching:
• Hypoglycemia risk is LOW as monotherapy (glucose-dependent action). Routine hourly checks not needed; standard SMBG and A1c follow.
• Pancreatitis (rare but reportable): severe abdominal pain radiating to the back, persistent nausea/vomiting — stop the drug and notify the provider.
• Severe joint pain — class warning; can occur weeks to years after initiation; usually resolves on discontinuation.
• Heart failure: saxagliptin and alogliptin associated with HF hospitalization — caution in HF patients.
• Renal dose adjustment: sitagliptin reduce dose in CrCl

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